Provider Demographics
NPI:1033578752
Name:BENNETT, EVERETT G III (NP)
Entity Type:Individual
Prefix:
First Name:EVERETT
Middle Name:G
Last Name:BENNETT
Suffix:III
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:TREY
Other - Middle Name:
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:11001 HAUSER ST.
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66210
Mailing Address - Country:US
Mailing Address - Phone:913-353-4703
Mailing Address - Fax:949-543-2954
Practice Address - Street 1:11001 HAUSER ST
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66210-6621
Practice Address - Country:US
Practice Address - Phone:913-353-4703
Practice Address - Fax:949-543-2954
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-23
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-77127-041363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner